Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
  • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
  • A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B2018/2005—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser with beam delivery through an interstitially insertable device, e.g. needle
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
  • A61B2018/2255—Optical elements at the distal end of probe tips
  • A61B2018/2261—Optical elements at the distal end of probe tips with scattering, diffusion or dispersion of light
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
  • A61B2018/2255—Optical elements at the distal end of probe tips
  • A61B2018/2272—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam

Definitions

• the present invention relates to a light treatment instrument, in particular to an endovenous laser that can be used for treating varicose veins.
• Phlebectomy is a heavy and expensive surgical procedure. In addition, it is a generator of scars.
• the object of the invention is to provide a simpler technique and equipment, instrument and system, less expensive and easier to handle.
• such an instrument comprises a light guide, for example an optical fiber, and a rigid support for the guide, for example a needle forming a sheath around the light guide.
• Such an optical needle would be connected to a laser source of variable wavelength by a light vector connected on both sides to the laser and the needle by a standard plug (SMA or other), chemically resterilizable for the use in a sterile surgical environment.
• SMA standard plug
• a certain rigidity that is brought by the support.
• this rigidity is not absolute, but rather to compare with the flexibility of an optical fiber as used, especially endovenous laser.
• This rigidity can be varied depending on the use. For example in the case of a beveled needle, it can be rigid enough to allow to stitch through the skin of a patient.
• the needle may have an outer diameter in the range of 0.45 mm to 1 mm.
• the light guide may have an outer diameter of 200 to 1000 microns (1 mm).
• the instrument may comprise connection means to a light source, in particular to a laser light source.
• the laser light source may have a wavelength of between 800 and 980nm, which is suitable for endovascular use. Other wavelengths are also possible depending on the application.
• the needle can be straight or curved. The length of the needle and the light guide may vary depending on the application.
• the light guide may comprise, for example, an inner lining of a tubular needle.
• This dressing will advantageously be made of silica.
• the instrument may comprise an optical fiber as a light guide, for example a fiber of a type commonly used for medical applications.
• This fiber can be mounted in a tubular needle.
• the instrument may comprise means for a substantially frontal emission of the light and / or for lateral emission of the light. Lateral diffusion can be done through one or more side windows. Depending on the intended use, the windows may be distributed transversely or longitudinally along the light guide and / or the support.
• the instrument may further comprise a channel, the reflux of blood in the channel attesting to the good intravascular position of the needle; a channel may also be provided for injecting anesthetic.
• a processing system may comprise a laser light source.
• the wavelength of this light is advantageously between 800 and 1000 nm. Even more advantageously, this wavelength is 980 nm, because of its preferential absorption by oxygenated hemoglobin and water.
• a laser light treatment method may advantageously use an instrument or a system according to the invention. It can especially be used for vascular applications, especially for the treatment of varicose veins. For their treatment, the laser can be used for varicose sclerosis. It can also be used for arterial occlusion, replacing chemical embolization.
• the instrument according to the invention is pierced with the right of a varix to be treated, through the skin, as for a puncture.
• the bite may be under visual control or under ultrasound control.
• the instrument can itself be used for the injection of anesthetic through a channel provided for this purpose, thus avoiding a sting and the use of an additional syringe.
• a channel possibly the same, can also be provided to check the blood flow. It is thus possible to check the correct positioning of the instrument in the vascular system. Perivascular intumescence anesthesia is performed. The locating can be done under ultrasound.
• the instrument is then removed, which may be unloaded with a sterile pad.
• the instrument is then ready to treat another varix. Direct puncture without a guiding needle is also possible
• the optical fiber used may be a fiber of a current type, in particular of a type used for interventional fibroscopies, endovenous laser, surgery ....
• the cost of an instrument according to the invention can be divided by five or ten relative to an instrument currently used for the treatment of varices by laser light if it is manufactured on a large scale.
• FIG. 1 is a schematic view of a system according to the invention, in use
• FIG. 2 is a longitudinal sectional view of a first embodiment for a needle comprising an optical guide in the form of an optical fiber and in which the diffusion of light is through an axial opening;
• FIG. 3 is a cross section along III of the needle of Figure 2;
• FIG. 4 is sectional on one end of a light guide adapted for lateral diffusion of light, a second embodiment
• FIG. 5 is a cross-section, similar to that of FIG. 2, of a third embodiment, in which the light guide is applied to the inner wall of the needle, and in which the diffusion of light is through an axial opening;
• FIG. 6 is a cross-section, similar to that of FIGS. 2 and 5, of a third embodiment, in which the light guide is applied to the. inner wall of the needle, and wherein the light is diffused through an axial opening and lateral openings;
• FIG. 7 is a cross section along VII of the needle of Figure 5.
• FIG. 8 is a cross-section along VIII of the needle of FIG. 6.
• the term needle means a tubular needle, sufficiently rigid to allow precise handling of the light guide.
• this needle must be rigid enough to pierce the skin, such as a puncture needle.
• FIG. 1 very schematically illustrates the use of an instrument 1 according to the invention for the treatment of a varix 2.
• the instrument has the shape of a needle 3 containing a guide for laser light. The contact of the guide with the tip of the needle can be conical in order to nested in a consistent manner.
• the instrument comprises coupling means 4 for a source 5 of laser light.
• An optical cable 7 connects the laser source 5 and the coupling means 4.
• the needle 3 has been stitched in a lower limb 6.
• a distal end 8 of the needle that is to say its end farthest from the light source 5, is introduced into one end of the varix 2.
• a laser firing can then be performed through the distal end 8 of the needle to cause sclerosis of the tip of the varix, thereby preventing the influx of blood into the varix.
• Several laser shots can be made along the treated varicose, approximately every two mm while gradually withdrawing the needle. Markers can then be provided on a sheath of the needle.
• Figures 2 and 3 illustrate a first embodiment for an instrument 1 according to the invention.
• the instrument comprises a tubular needle.
• the needle 10 is beveled at the distal end 8 of the instrument 1.
• the instrument further comprises an optical fiber 11, also bevelled at the distal end 8.
• the needle 10 forms a sheath tubular for the optical fiber 11.
• the beveled distal end 81 of the optical fiber 11 extends beyond the distal end 80 beveled of the needle 10 in order to let the laser light diffuse.
• the instrument comprises at its proximal end, connecting means 4 to an optical cable 7 connecting it to a laser source, not shown in Figures 2 and 3.
• a channel space 12 between the needle and the fiber may be used to inject anesthetic, prior to laser firing. This space can also be used to verify that the distal end 8 is well positioned, the blood reflux in the needle being an index.
• the instrument of FIG. 2 is designed to ensure a frontal diffusion of the light, that is to say substantially in the axis of the optical fiber 12.
• the bevel at the end of the fiber makes it possible to depose laterally the diffusion of a part of the light.
• FIGS. 5 and 7 A third embodiment will now be described for an instrument according to the invention, with reference to FIGS. 5 and 7, only in that it differs from that of FIG. 2.
• the light guide 14 is not an optical fiber independent of the needle.
• the light guide is made by a covering 14 of the interior of the needle 10.
• This dressing is integral with the needle on the entire surface and dressed. Being silica, it has the same light guiding qualities as an optical fiber. It also benefits from the protection of the sheath that forms the needle 10, particularly in terms of strength and impact protection. In addition, the dressing being secured to the needle, the accuracy of the instrument is increased.
• the bevel at the distal end 8 of the instrument identically affects the needle and its covering, the distal ends of the light guide and the needle being substantially merged.
• FIGS. 6 and 8 illustrate a fourth embodiment, a variant of the embodiment of FIG. 5.
• FIG. 1 in addition to the opening allowing a substantially frontal diffusion of the light through the distal end 8, FIG. 1 comprises two lateral windows 16. These windows are formed transversely through the wall of the needle and through its covering, away from the distal end 8. The windows are arranged substantially aligned along a generatrix of the cylinder formed by the needle. Such windows allow simultaneous lateral and frontal scattering of the light. Their provisions can be chosen according to the particular area to be treated.
• the light guide for example an optical fiber to extend beyond the support, for example a needle.
• the fiber exceeds 0 to 1cm, preferably about 5mm.
• means may be provided for retracting the fiber in the needle and means for extending the optical fiber beyond the distal end of the needle into a working position.
• an instrument according to the invention can be used for other vascular applications, for example the sclerosis of varicose veins not only on the lower limbs, but also of pelvic or oesophageal varices, hemorrhoids, or vascular sclerosis. surgical operations. It is also possible to use an instrument according to the invention for performing a tissue perforation, or as an alternative to biological glues, of the cyanoacrylate type, for any intravascular embolization, in particular for congenital or acquired fistulas, or venous, especially for malformations or angiomas.
• tissue debridement in contact mode, for example applied to ulcers.
• An instrument according to the invention can also be used for the destruction of tissue metastases, for example intrahepatic, more ergonomic and less expensive than radiofrequency.
• Laser tissue destruction involves a phenomenon of photon tissue absorption with secondary conversion to heat. Since this absorption is targeted at certain tissue-specific molecular components (chromophores), the thermal effect is more specific than another method of thermal heating of tissues such as radiofrequency for example. This specificity allows new applications of lasers such as dynamic phototherapy in oncology for example.
• the use of a rigid support for the light guide allows a more precise use and a superior maneuverability.
• the lesions caused by the treatment are more precise.
• Biological stimulation improves healing. Hemorrhage is reduced, as well as the risk of infection, carbonization involving temperatures close to or greater than 350 0 C or 400 0 C, which corresponds to tissue glow. Postoperative pain is also reduced, particularly in the case of ulcer debridement; There are fewer post-operative infections. There is secondary inhibition of inflammation and algogenic factors at the level of nerve endings.
• parameters can be adjustable, for example the wavelength, the time of emission and laying between each shot, the fluence, the irradiance, the continuous or pulse mode (single or multiple) or the area destruction according to the optical scattering at the end of the light guide.
• the light guide may be of a material other than silica, depending on the laser wavelength.

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Citations (7)

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• 2006
  • 2006-03-13 US US12/282,401 patent/US8454586B2/en active Active
  • 2006-03-13 ES ES06726075.2T patent/ES2469593T3/es active Active
  • 2006-03-13 WO PCT/FR2006/000546 patent/WO2007104836A1/fr active Application Filing
  • 2006-03-13 EP EP06726075.2A patent/EP1996106B1/de active Active

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